This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Enhancement of Specificity With Free PSA Measurements

William J. Catalona, MD; Deborah S. Smith, PhD; David K. Ornstein, MD

JAMA. 1997;277(18):1452-1455.

Abstract
Objective.
—To determine the detection rate of prostate cancer in a screening population of men with prostate-specific antigen (PSA) concentrations of 2.6 to 4.0 ng/mL and a benign prostate examination, to assess the clinicopathological features of the cancers detected, and to assess the usefulness of measuring the ratio of free to total PSA to reduce the number of prostatic biopsies.

Design.
—A community-based study of serial screening for prostate cancer with serum PSA measurements and prostate examinations.

Setting.
—University medical center.

Subjects.
—A total of 914 consecutive screening volunteers aged 50 years or older with serum PSA levels of 2.6 to 4.0 ng/mL who had a benign prostate examination and no prior screening tests suspicious for prostate cancer, 332 (36%) of whom underwent biopsy of the prostate.

Main Outcome Measures.
—Cancer detection rate, clinical and pathological features of cancers detected, and specificity for cancer detection using measurements of percentage of free PSA.

Results.
—Cancer was detected in 22% (73/332) of men who underwent biopsy. All cancers detected were clinically localized, and 81% (42/52) that were surgically staged were pathologically organ confined. Ten percent of the cancers were clinically low-volume and low-grade tumors, and 17% of those surgically staged were low-volume and low-grade or moderately low-grade tumors (possibly harmless). Using a percentage of free PSA cutoff of 27% or less as a criterion for performing prostatic biopsy would have detected 90% of cancers, avoided 18% of benign biopsies, and yielded a positive predictive value of 24% in men who underwent biopsy.

Conclusions.
—There is an appreciable rate of detectable prostate cancer in men with serum PSA levels of 2.6 to 4.0 ng/mL. The great majority of cancers detected have the features of medically important tumors. Free serum PSA measurements may reduce the number of additional biopsies required by the lower PSA cutoff.

Author Affiliations
From the Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.

Footnotes
Reprints: William J. Catalona, MD, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's PI, St Louis, MO 63110.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Undetectable Prostate-Specific Antigen in the Absence of Previous Prostatectomy: Laboratory Error or True Finding?
Chisholm et al.
Lab Med 2009;40:466-469.
FULL TEXT  

Clinical Significance of Measuring Prostate-Specific Antigen
Arneth
Lab Med 2009;40:487-491.
ABSTRACT | FULL TEXT  

The Clinical Utility of Tumor Markers
Handy
Lab Med 2009;40:99-103.
ABSTRACT | FULL TEXT  

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers
Sturgeon et al.
Clin. Chem. 2008;54:e11-e79.
ABSTRACT | FULL TEXT  

Pathologic Characteristics of Cancers Detected in the Prostate Cancer Prevention Trial: Implications for Prostate Cancer Detection and Chemoprevention
Lucia et al.
Cancer Prevention Research 2008;1:167-173.
ABSTRACT | FULL TEXT  

Oligosaccharide Profiles of the Prostate Specific Antigen in Free and Complexed Forms from the Prostate Cancer Patient Serum and in Seminal Plasma: a Glycopeptide Approach
Tajiri et al.
Glycobiology 2008;18:2-8.
ABSTRACT | FULL TEXT  

Prostate-specific antigen in the early detection of prostate cancer
Thompson and Ankerst
CMAJ 2007;176:1853-1858.
ABSTRACT | FULL TEXT  

Role of transrectal ultrasonography in the prediction of prostate cancer: artificial neural network analysis.
Lee et al.
J Ultrasound Med 2006;25:815-821.
ABSTRACT | FULL TEXT  

Population-based screening for prostate cancer by measuring free and total serum prostate-specific antigen in Iran
Safarinejad
Ann Oncol 2006;17:1166-1171.
ABSTRACT | FULL TEXT  

Detection of Prostate Cancer at Low and Intermediate Serum Prostate-Specific Antigen Levels in a Country with a Low Incidence of Prostate Cancer
Lee et al.
Jpn J Clin Oncol 2006;36:376-380.
ABSTRACT | FULL TEXT  

Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial.
Thompson et al.
JNCI J Natl Cancer Inst 2006;98:529-534.
ABSTRACT | FULL TEXT  

Urine Markers as Possible Tools for Prostate Cancer Screening: Review of Performance Characteristics and Practicality
Muller and Brenner
Clin. Chem. 2006;52:562-573.
ABSTRACT | FULL TEXT  

The Changing Face of Prostate Cancer
Cooperberg et al.
JCO 2005;23:8146-8151.
ABSTRACT | FULL TEXT  

Robust prostate cancer marker genes emerge from direct integration of inter-study microarray data
Xu et al.
Bioinformatics 2005;21:3905-3911.
ABSTRACT | FULL TEXT  

Prostate-Specific Antigen Levels in the United States: Implications of Various Definitions for Abnormal
Welch et al.
JNCI J Natl Cancer Inst 2005;97:1132-1137.
ABSTRACT | FULL TEXT  

Adenocarcinoma of the Prostate: Epidemiological Trends, Screening, Diagnosis, and Surgical Management of Localized Disease
Routh and Leibovich
Mayo Clin Proc. 2005;80:899-907.
ABSTRACT  

Prospective Study of Quantitation of Plasma DNA Levels in the Diagnosis of Malignant versus Benign Prostate Disease
Boddy et al.
Clin. Cancer Res. 2005;11:1394-1399.
ABSTRACT | FULL TEXT  

Prostate-Specific Antigen and Free Prostate-Specific Antigen in the Early Detection of Prostate Cancer: Do Combination Tests Improve Detection?
Etzioni et al.
Cancer Epidemiol. Biomarkers Prev. 2004;13:1640-1645.
ABSTRACT | FULL TEXT  

Effect of Verification Bias on Screening for Prostate Cancer by Measurement of Prostate-Specific Antigen
Punglia et al.
NEJM 2003;349:335-342.
ABSTRACT | FULL TEXT  

Verification Bias and the Prostate-Specific Antigen Test -- Is There a Case for a Lower Threshold for Biopsy?
Schroder and Kranse
NEJM 2003;349:393-395.
FULL TEXT  

Management of High-Risk Populations with Locally Advanced Prostate Cancer
Khan and Partin
The Oncologist 2003;8:259-269.
ABSTRACT | FULL TEXT  

Managing the Risks of Prostate Disease During Testosterone Replacement Therapy in Older Men: Recommendations for a Standardized Monitoring Plan
Bhasin et al.
J Androl 2003;24:299-311.
FULL TEXT  

Should Routine Screening for Prostate-Specific Antigen Be Recommended?
Oottamasathien and Crawford
Arch Intern Med 2003;163:661-663.
FULL TEXT  

Biology of Prostate-Specific Antigen
Balk et al.
JCO 2003;21:383-391.
ABSTRACT | FULL TEXT  

Screening for Prostate Cancer: An Update of the Evidence for the U.S. Preventive Services Task Force
Harris and Lohr
ANN INTERN MED 2002;137:917-929.
ABSTRACT | FULL TEXT  

Improving the utility of prostate specific antigen (PSA) in the diagnosis of prostate cancer: the use of PSA derivatives and novel markers
Jain et al.
Postgrad. Med. J. 2002;78:646-650.
ABSTRACT | FULL TEXT  

Association Studies of Serum Prostate-specific Antigen Levels and the Genetic Polymorphisms at the Androgen Receptor and Prostate-specific Antigen Genes
Xu et al.
Cancer Epidemiol. Biomarkers Prev. 2002;11:664-669.
ABSTRACT | FULL TEXT  

Clinical Evaluation of the Elecsys Total Prostate-specific Antigen Assay on the Elecsys 1010 and 2010 Systems
Haese et al.
Clin. Chem. 2002;48:944-947.
FULL TEXT  

Novel Artificial Neural Network for Early Detection of Prostate Cancer
Djavan et al.
JCO 2002;20:921-929.
ABSTRACT | FULL TEXT  

Andropause: Clinical Implications of the Decline in Serum Testosterone Levels With Aging in Men
Matsumoto
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2002;57:M76-99.
FULL TEXT  

Prostate-Specific-Antigen Testing for Early Diagnosis of Prostate Cancer
Barry
NEJM 2001;344:1373-1377.
FULL TEXT  

Insulin-Like Growth Factor I (IGF-I) and IGF-Binding Protein-3 in Benign Prostatic Hyperplasia and Prostate Cancer
Khosravi et al.
J. Clin. Endocrinol. Metab. 2001;86:694-699.
ABSTRACT | FULL TEXT  

Prostate Cancer: What Is the Future Role for Imaging?
Thornbury et al.
Am. J. Roentgenol. 2001;176:17-22.
FULL TEXT  

Comparative Efficiency of Prostate-Specific Antigen Screening Strategies for Prostate Cancer Detection
Ross et al.
JAMA 2000;284:1399-1405.
ABSTRACT | FULL TEXT  

Serum Human Glandular Kallikrein-2 Protease Levels Predict the Presence of Prostate Cancer Among Men With Elevated Prostate-Specific Antigen
Nam et al.
JCO 2000;18:1036-1036.
ABSTRACT | FULL TEXT  

Ratio of Free or Complexed Prostate-specific Antigen (PSA) to Total PSA: Which Ratio Improves Differentiation between Benign Prostatic Hyperplasia and Prostate Cancer?
Jung et al.
Clin. Chem. 2000;46:55-62.
ABSTRACT | FULL TEXT  

The Combination of Human Glandular Kallikrein and Free Prostate-specific Antigen (PSA) Enhances Discrimination Between Prostate Cancer and Benign Prostatic Hyperplasia in Patients with Moderately Increased Total PSA
Magklara et al.
Clin. Chem. 1999;45:1960-1966.
ABSTRACT | FULL TEXT  

Estimation of Prostate Cancer Probability by Logistic Regression: Free and Total Prostate-specific Antigen, Digital Rectal Examination, and Heredity Are Significant Variables
Virtanen et al.
Clin. Chem. 1999;45:987-994.
ABSTRACT | FULL TEXT  

Detection of Prostate and Colon Cancer
Stern et al.
JAMA 1998;280:117-118.
FULL TEXT  

Use of the Percentage of Free Prostate-Specific Antigen to Enhance Differentiation of Prostate Cancer From Benign Prostatic Disease: A Prospective Multicenter Clinical Trial
Catalona et al.
JAMA 1998;279:1542-1547.
ABSTRACT | FULL TEXT  

Detection of Early Prostate Cancer: Serendipitous or Systematic?
Iczkowski et al.
JAMA 1998;279:1439-1441.
FULL TEXT  

A 73-Year-Old Man With Symptomatic Benign Prostatic Hyperplasia
Barry
JAMA 1997;278:2178-2184.
ABSTRACT  

PSA Thresholds for Prostate Cancer Detection
Moul
JAMA 1997;278:699-699.
ABSTRACT  

PSA Thresholds for Prostate Cancer Detection
Peirce et al.
JAMA 1997;278:700-700.
ABSTRACT  

PSA Thresholds for Prostate Cancer Detection-Reply
Carter
JAMA 1997;278:701-701.
ABSTRACT  

PSA Thresholds for Prostate Cancer Detection
Parker
JAMA 1997;278:699-700.
ABSTRACT  

Free PSA as a Percentage of the Total: Where Do We Go from Here?
Moore
Clin. Chem. 1997;43:1561-1562.
FULL TEXT  

FREE PSA CONCENTRATION TO DETECT PROSTATE CANCER
JWatch General 1997;1997:4-4.
FULL TEXT  

Screening Strategies for Cancer: Implications and Results
Chabner et al.
JAMA 1997;277:1475-1476.
ABSTRACT